PRESTIGE VIP CORPORATE
A comprehensive plan
offering superior benefits
and free choice of medical providers
DEDUCTIBLE OPTIONS*
| Option I | Option II | Option III | Option IV | Option V | Option VI | Option VII | |
|---|---|---|---|---|---|---|---|
| C$250 | CS$500 | C$1,000 | C$2,500 | C$5,000 | C$10,000 | C$20,000 |
*Only one deductible per person, per policy year applies. For family policies, a maximum of two deductibles accumulated per policy, per policy year will be applied. For more information, please refer to the Conditions of Coverage of the policy
TABLE OF BENEFITS
| Description | Coverage |
|---|---|
| Maximum coverage per person up to the age of 75 | Choice of • C$1,000,000; • C$2,000,000; or • C$5,000,000 |
| Maximum coverage per person at the age of 75 and up | C$500,000 |
| Age limit to apply | 75 |
| Geographical cover | Worldwide without restrictions of doctors and hospitals |
| Description | Coverage |
|---|---|
| Private hospital room | 100% UCR |
| Intesive care unit | C$5,000 per day, max. of 90 days |
| Prescribed medications | 100% UCR |
| Description | Coverage |
|---|---|
| Emergency room | 100% UCR |
| Physician and specialist visits | 100% UCR |
| Prescription medication | C$5,000 |
| Description | Coverage |
|---|---|
| Emergency medical services | 100% UCR |
| Diagnostic study services (laboratory tests, pathology, X-rays, MRI/CT/PET scans) | 100% UCR |
| Cancer tests, medication and treatment (chemotherapy and/or radiotherapy and/or molecular profiling) | 100% UCR |
| Dialysis | 100% UCR |
| Organ transplant (per lifetime) | C$1,000,000 |
| Benefits for live donors (per lifetime) | C$30,000 |
| Durable medical equipment | C$5,000 |
| Physical therapy and rehabilitation (including nurse care at home) | C$5,000 |
| Congenital conditions diagnosed before age 18 (per lifetime) | C$150,000 |
| Congenital conditions diagnosed after age 18 (per lifetime) | C$1,000,000 |
| Surgery | 100% UCR |
| Description | Coverage |
|---|---|
| Maternity | 50% of the first C$100,000 of eligible expenses, then 100% UCR up toC$250,000 |
| Inclusion of the newborn | Automatic if born from a covered maternity |
| Description | Coverage |
|---|---|
| Emergency transportation by ground ambulance | 100% UCR |
| Emergency transportation by air ambulance (per lifetime) | C$45,000, no deductible applies |
| Repatriation of mortal remains | C$5,000 |
| Description | Coverage |
|---|---|
| Emergency dental coverage | 100% UCR for the first 180 days |
| Second Medical Opinion VIP | Access to the medical opinion of internationally renowned expertsfrom around the world regarding a condition, without deductible |
| Reintroduction into Canada | Coordination of ongoing treatment with medical providers in Canadato reintroduce the treatment and management of a condition intoCanada’s health system after being diagnosed abroad |
| Description | Coverage |
|---|---|
| Annual executive check-up | 100% UCR including but not limited to physical evaluations, diagnosticprocedures, nutritionist, smoking cessation treatments, human papillomavirus (HPV) test and/or vaccinations (25% surcharge) |
| Travel expenses | C$5,000 for transportation and accommodation expenses whenreceiving treatment more than 320 kms from the Insured’s residence (5%surcharge) |
| Reduced diagnostic deductible | C$250 diagnostic deductible for bloodwork, ultrasound and MRI (7%surcharge) |
| Increased outpatient medication benefit | Additional C$45,000 for outpatient medication (5% surcharge) |
| Pre-existing conditions waiting period waiver | For groups of 50+ employees; waiver of the 24-month pre-existingcondition waiting period based on a questionnaire of 2 medical questions;a separate pre-exclusion waiver form for corporate groups must becompleted by all employees (20% surcharge) |
| Conversion option | Conversion to an individual plan for employees and eligible spouses whohave been continually covered for at least 2 years from the effective date(25% surcharge) |
All benefits with 100% coverage are up to the policy limit. There is a minimum requirement of 3 employees to be eligible for this Corporate Plan. Any pre-existing medical conditions diagnosed 24 months prior to the effective date of the policy will not receive coverage for the first 24 months from the effective date, unless the optional pre-existing conditions waiting period waiver for groups of 50 or more employees has been acquired.
For the purpose of the Insurance Companies Act (Canada), this policy is issued under the license of Humania Assurance Inc. business in Canada. Administration services for this policy are provided by VUMI® Canada, Inc. in partnership with VIP Universal Medical Insurance Group, LLC. VUMI® is a registered mark of VIP Universal Medical Insurance Group, LLC and licensed under agreement to VUMI® Canada, Inc. Humania Assurance Inc. is a Canadian company based in Quebec and authorized under the Insurance Companies Act in Canada.